Three Types of Adverse Childhood Experiences, and Alcohol and Drug Dependence Among Adults: An Investigation Using Population-Based Data.

BACKGROUND: There are several gaps in the literature on the link between adverse childhood experiences (ACEs) and substance use, including the impact of less direct forms of abuse, such as witnessing domestic violence, and the role of gender as a moderator of the relationship.

OBJECTIVES: To estimate associations between three types of ACEs (sexual abuse, physical abuse, and exposure to parental domestic violence), when mutually adjusted, and two substance dependence outcomes (alcohol and drug dependence), while considering the potential moderating role of gender and the effects of a range of potential explanatory factors.

METHODS: Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (2012) using logistic regression (n = 21,554). A series of models were tested separately for each outcome, including ACEs, gender, race, and age. First, gender interactions were tested. Next, potential explanatory factors were entered into the models and the extent of attenuation was noted. These factors included: depression, anxiety, smoking, pain, insomnia, social support, and socioeconomic status

RESULTS: All three ACEs are associated with significantly higher odds of alcohol and drug dependence, even when controlling for all factors simultaneously; however, no strong evidence for gender interactions was found. In the fully adjusted model, odds ratios for drug dependence vary from 2.52 (sexual abuse) to 1.34 (exposure to domestic violence). The comparable range for alcohol dependence is 2.13 (physical abuse) to 1.49 (exposure to domestic violence).

CONCLUSIONS/IMPORTANCE: Three types of ACEs, including direct and indirect forms of violence, are independently related to lifetime drug and alcohol dependence among adult Canadians.